BMJ Open Quality最新文献

{"title":"Evaluation of the implementation of personalised outcomes forecasts to optimise supervised exercise therapy in patients with intermittent claudication: a multimethods process evaluation.","authors":"Laura H M Marcellis, Anneroos Sinnige, Anne G E van Bergen, Steffie Spruijt, Andrew Kittelson, Joep A W Teijink, Philip J van der Wees, Thomas J Hoogeboom","doi":"10.1136/bmjoq-2024-002920","DOIUrl":"10.1136/bmjoq-2024-002920","url":null,"abstract":"<p><strong>Background: </strong>Personalised outcomes forecasts (POFs) were introduced among physical and exercise therapists in the Netherlands to optimise supervised exercise therapy for patients with intermittent claudication. Yet, therapists' initial adoption and sustainable implementation of POFs can be influenced by various factors.</p><p><strong>Objectives: </strong>The purpose of this study was to examine therapists' adoption of the POFs, their fidelity to the measurement protocol for supervised exercise therapy, and their perceived barriers and facilitators for using POFs in practice.</p><p><strong>Methods: </strong>A multimethod process evaluation was conducted, including quantitative descriptive and pre-post approaches, as well as a qualitative framework approach. To examine adoption, we evaluated the proportion of therapists who expressed interest in POFs by completing one of three provided e-learnings and the proportion of therapists who started using POFs in practice. To examine fidelity to the measurement protocol, we compared the per-episode proportion of follow-up measurements documented by therapists preimplementation and postimplementation. Qualitative data on barriers and facilitators were identified through semistructured interviews with therapists.</p><p><strong>Results: </strong>One year after the implementation, 89% of therapists eligible to use POFs (n=1727) completed at least one e-learning and 51% of therapists started using POFs. The per-episode proportion of documented follow-up measurements per therapist increased, from a mean rate of 37% (3 months) and 22% (6 months) during the preimplementation period to a mean rate of 53% (3 months) and 32% (6 months) during the postimplementation period (p<0.001). Among interviewed therapists (n=12), identified barriers included competing demands and a lack of skills or confidence. Identified facilitators included the potential to improve the quality of care and a positive user attitude.</p><p><strong>Conclusions: </strong>Our findings suggest that although there is initial interest in and adoption of POFs, addressing barriers and leveraging facilitators through tailored implementation strategies could further increase their utilisation in practice.</p>","PeriodicalId":9052,"journal":{"name":"BMJ Open Quality","volume":"14 1","pages":""},"PeriodicalIF":1.3,"publicationDate":"2025-01-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11751796/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142999868","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Synesis as a framework to enable safety interventions in complex healthcare environments.","authors":"Aarti Bavare, Tiffany Wrenn, Anne Lam, Jamie Cargill, Lauren Salinas, Itode Idowu, Asma Razavi, Venessa Lynn Pinto, Eric Williams","doi":"10.1136/bmjoq-2024-002880","DOIUrl":"10.1136/bmjoq-2024-002880","url":null,"abstract":"<p><strong>Background: </strong>Despite wide adoption in the healthcare of safety event report (SER) systems, there is a paucity of unified structures for prompt analysis and action while retaining reporter confidentiality. We used a synesis framework to change siloed reviews of safety reports to a comprehensive appraisal of quality, safety, productivity and reliability to facilitate interventions.</p><p><strong>Methods: </strong>After a needs assessment survey, we launched serial plan-do-study-act cycles to (1) enhance teams' ability to access SERs, (2) facilitate regular multidisciplinary review of SERs to identify actionable opportunities, (3) allocate action priority using failure mode and effects analysis, and (4) launch actions and summarise data. Team of Teams model allowed for empowered execution. Measures included process-completion of review, team engagement, proportion of 'open' (those without action plan) reports within 1 month of filing; outcome-number of actions launched and completed, dissemination of actions and postintervention survey results; and balancing-resources invested.</p><p><strong>Results: </strong>26 multidisciplinary leaders reviewed 3175 of the 3406 total reported SERs across four clinical units over 18 months. The proportion of reviewed to total SERs increased significantly from the first 6 months (75%) to the second 12 months (99%) (p<0.001), and the proportion of 'open' to reviewed SERs decreased significantly from 43% to 5.3% (p<0.001). Many local- and organisational-level actions were launched efficiently by the engaged and aligned team. Action impact was assessed by reviewing trends in SER themes and findings, and actions and impact were disseminated at unit, divisional and organisational levels. Postintervention survey showed improvement in leaders' perceptions about SER reviews.</p><p><strong>Summary: </strong>We successfully implemented a sustainable process to comprehensively review, prioritise and act on SERs in our large institution and facilitated safety interventions using a synesis framework.</p>","PeriodicalId":9052,"journal":{"name":"BMJ Open Quality","volume":"14 1","pages":""},"PeriodicalIF":1.3,"publicationDate":"2025-01-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11867619/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142999869","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Implementation of patient-reported outcome dashboards within the electronic health record to support shared decision-making in serious chronic illness.","authors":"Laura M Perry, Nisha A Mohindra, Ava Coughlin, Katy Bedjeti, Cynthia Barnard, Sofia F Garcia, Devin Peipert, Sheetal M Kircher, Vikram Aggarwal, Jeffrey Linder, Melissa Weitzel, Victoria Morken, Elijah Patten, Jissell Torres, Mary O'Connor, Susan Metzger, Alesia O'daniel, Ryan Chmiel, Reena Modi, Michelle Munroe, Stavroula Xinos, Glyn Elwyn, Eugene Nelson, Aricca Van Citters, David Cella, Lisa Hirschhorn","doi":"10.1136/bmjoq-2024-002837","DOIUrl":"10.1136/bmjoq-2024-002837","url":null,"abstract":"<p><strong>Background: </strong>Attending to patient-reported outcomes (PROs) using data visualisation dashboards could enhance shared decision-making (SDM) and care delivery for serious chronic illnesses. However, few studies have evaluated real-world strategies and resulting implementation outcomes of PRO dashboards.</p><p><strong>Method: </strong>From June 2020 to January 2022, we implemented an electronic health record (EHR)-integrated PRO dashboard for advanced cancer and chronic kidney disease. Based on implementation science guidelines (eg, Framework for Reporting Adaptations and Modifications to Evidence-based Implementation Strategies, Reach, Effectiveness, Adoption, Implementation, Maintenance), we monitored use and captured adaptations in implementation strategies. Clinicians (n=7) and patients (n=30) responded to a 6-month survey that included appropriateness, acceptability, adoption and sustainability.</p><p><strong>Results: </strong>Out of 1450 eligible patients, 748 (52%) completed at least one PRO invitation (reach). 37% of PRO questionnaire invitations (1421/3882) were completed (fidelity to PRO completion), with higher rates occurring when more implementation strategies were adopted. Among completed postvisit surveys from patients, 57% indicated that the dashboard was discussed at an eligible visit (fidelity to dashboard use). In the 6-month survey, patients endorsed the dashboard's acceptability and appropriateness: 77% felt it frequently provided clear information and 63% felt it frequently met their needs. Most patients (77%) and clinicians (86%) valued the dashboard for increasing SDM, and 57% of clinicians endorsed the dashboard's clinical sustainability.</p><p><strong>Discussion: </strong>This pilot study demonstrated the clinical appropriateness, acceptability and feasibility of implementing an EHR-integrated PRO dashboard for advanced cancer and chronic kidney disease. Results also point to areas for improvement, including strategies to further support patient and clinician engagement, PRO completion and sustainability in real-world implementation.</p>","PeriodicalId":9052,"journal":{"name":"BMJ Open Quality","volume":"14 1","pages":""},"PeriodicalIF":1.3,"publicationDate":"2025-01-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11752041/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142969619","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Improving 1-year liver allograft survival hazard ratios.","authors":"Resham Ramkissoon, Ashley Rosier, Savitha Iyengar, Timucin Taner, William Sanchez","doi":"10.1136/bmjoq-2024-002899","DOIUrl":"10.1136/bmjoq-2024-002899","url":null,"abstract":"<p><strong>Background: </strong>The Scientific Registry for Transplant Recipients (SRTR) publishes outcomes of all transplant centres in the USA two times a year. The outcomes are publicly available and used by insurance payers and patients to assess the performance of a programme. Poor performance can result in temporary suspension or termination of a transplant programme. The estimated 1-year survival hazard ratio (EHR) is an important metric publicly reported by the SRTR.</p><p><strong>Problem: </strong>The EHR at our institution was 1.13, indicating a graft loss rate that was 13% higher than the national average.</p><p><strong>Methods/intervention: </strong>We defined an improvement in this metric as achieving an EHR of <1.0. Our balance measure was maintaining similar liver transplant volumes and avoiding limiting access to transplant. Using a causality tree, we identified there was no 'real time' assessment of programme risk or objective metric to assess this. An affinity diagram was used to determine high and intermediate risk factors for mortality and graft loss and, using a REDCap form (a web application used to manage our database) to track actual and potential complications, we calculated a weekly 'risk metric' that was introduced at multidisciplinary selection conference meetings.</p><p><strong>Results: </strong>We remeasured our EHR at each interval release of the SRTR outcomes and found it to be 0.98 and 0.65 after implementing the 'risk metric.' During the intervention period, annual liver transplant volume remained above the baseline measure.</p><p><strong>Conclusion: </strong>By implementing a 'risk metric' to prospectively assess the risk of a low EHR at transplant selection committee meetings, we were able to reduce the EHR well below the national average without limiting access to liver transplants.</p>","PeriodicalId":9052,"journal":{"name":"BMJ Open Quality","volume":"14 1","pages":""},"PeriodicalIF":1.3,"publicationDate":"2025-01-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11752011/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142969624","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Integration of a specialist pharmacist-led multidisciplinary team in primary care: preventing strokes in people with atrial fibrillation across North East London.","authors":"Mital Patel, Jagjot Kaur Chahal, John Robson, Shabana Ali, Richard Clements, Angela Theodoulou, Matt Kearney, Afzal Sohaib, Riyaz Patel, Sotiris Antoniou, Paul Wright","doi":"10.1136/bmjoq-2024-002804","DOIUrl":"10.1136/bmjoq-2024-002804","url":null,"abstract":"<p><p>Public Health England outlines a national ambition of anticoagulating 90% of eligible patients with atrial fibrillation (AF) by 2029. In 2019/2020, two out of three boroughs reviewed in this study were in the bottom 10% of boroughs compared with others within England. Stroke National Audit data for these three boroughs from 2019 to 2020 identified that in patients with known AF admitted to hospital with strokes, 37% were not anticoagulated. Evidence shows that one stroke can be prevented for every 25 patients with AF treated with anticoagulation, reducing the burden of stroke and stroke-related disabilities.In 2020, hospital specialist cardiovascular pharmacists were commissioned to identify patients with AF at high ischaemic risk (CHA₂DS₂VASc≥2) in three boroughs by working with general practitioners (GPs) and practice-based pharmacists. Using digital 'proactive care frameworks' created by UCLPartners and the Clinical Effectiveness Group, Queen Mary University of London, baseline searches of GP records enabled clinical teams to risk stratify and prioritise patients with AF for review. Patients not on anticoagulation were categorised as high risk and were reviewed for initiation of anticoagulation. The second priority was patients on dual antithrombotic therapy to determine if antiplatelet therapy could be stopped to minimise bleeding risk.At baseline (March 2020), nationally available data (extracted from CVDPREVENT) showed that 81% of patients with AF at high ischaemic risk across the three selected boroughs were anticoagulated. Repeated data extraction in March 2023, showed 94% of patients with AF at high ischaemic risk were anticoagulated, an absolute improvement of 13%, with 415 patients initiated on anticoagulant therapy over 3 years, translating to 17 strokes prevented. There was a 52% reduction in dual antithrombotic therapy, preventing an estimated three major bleeds.Improvements were achieved through a combination of specialist pharmacist reviews, GP and practice-based pharmacist training and virtual multidisciplinary reviews supporting the integration of specialists into a primary care setting to enable joined-up pathways for effective stroke prevention.</p>","PeriodicalId":9052,"journal":{"name":"BMJ Open Quality","volume":"14 1","pages":""},"PeriodicalIF":1.3,"publicationDate":"2025-01-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11751773/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142969561","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Five principles to prioritise in small-scale surgical quality improvement: a qualitative study of the views of surgical improvement leaders.","authors":"Clifford Y Ko, Alessandra Giusti, Graham Martin, Mary Dixon-Woods","doi":"10.1136/bmjoq-2024-002917","DOIUrl":"10.1136/bmjoq-2024-002917","url":null,"abstract":"<p><strong>Objective: </strong>Variations in the quality and safety of surgical care remain persistent. Efforts to improve are needed, but are themselves variably effective, with often disappointing impacts. When compared with large-scale, multisite and better resourced improvement efforts, the evidence base for small-scale quality improvement (QI) has remained under-developed and lacking in clarity on good practice. We aimed to identify experienced leaders' views on the principles that should guide small-scale QI projects in surgery.</p><p><strong>Methods: </strong>Two rounds of virtual focus groups were conducted with 10 QI leaders, comprising surgeons, anaesthetists and nurses from three countries (Ireland, the UK and the USA). All participants had formal training in improvement techniques and at least 10 years' experience leading small-scale QI efforts in surgery. Analysis was informed by the principles of the constant comparative method together with content analysis.</p><p><strong>Results: </strong>Analysis of the focus groups identified five principles to prioritise for small-scale surgical QI: ensure high-quality planning before project launch; understand the problem to be solved to define focused project aims; ensure improvement efforts are sensitive to time, capacity and local context; assemble the right improvement team and engage the relevant stakeholders; and use of a clear, structured framework to guide QI is likely to be very helpful.</p><p><strong>Conclusions: </strong>This study identifies five principles likely to be useful in guiding better surgical QI in frontline settings. These principles can help inform a structured framework to support small-scale surgical improvement efforts.</p>","PeriodicalId":9052,"journal":{"name":"BMJ Open Quality","volume":"14 1","pages":""},"PeriodicalIF":1.3,"publicationDate":"2025-01-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11751978/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142963713","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Reducing postoperative blood product usage and costs in cardiothoracic surgery: the implementation of a multispecialty perioperative care model incorporating a haemostasis checklist.","authors":"Christopher Daniel Smith, Adrian De Luca, Peter Hibbert, Krishnaswamy Sundararajan","doi":"10.1136/bmjoq-2024-002911","DOIUrl":"10.1136/bmjoq-2024-002911","url":null,"abstract":"<p><p>Transfusion of blood products following cardiothoracic surgery represents a significant proportion of national blood product usage, has significant cost implications and is associated with increased 30-day mortality. Following identification of an increase in blood product use, we implemented a healthcare improvement initiative using a perioperative care model and establishment of a new multispecialty cardiothoracic surgery taskforce to further define and tackle the problem. The initiative incorporated a bundle of preoperative identification of high-risk patients, an intraoperative haemostasis checklist, a programme of unit education focussing on bleeding postbypass and use of thromboelastography and introduction of postoperative protocols for identification and escalation of bleeding. Following intervention, a 60% reduction in blood product use within the first 12 hours of cardiopulmonary bypass was observed. Red cell, cryoprecipitate and fresh frozen plasma usage were particularly reduced with 57%, 47% and 72% reductions, respectively, following intervention and similar results were maintained on repeat audit 1-year postintervention, with on average 84 fewer blood products used per 100 patients. This resulted in an estimated cost saving of AU$36 928 per 100 patients. This quality initiative was successful in overcoming traditional silos of care and describes how quality improvement methodology utilising a multispecialty and multidisciplinary approach can be applied to solve complex issues in the perioperative period. Here, we demonstrate a reproducible and sustainable model for reducing blood product use in the cardiothoracic perioperative population.</p>","PeriodicalId":9052,"journal":{"name":"BMJ Open Quality","volume":"14 1","pages":""},"PeriodicalIF":1.3,"publicationDate":"2025-01-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11751888/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142944323","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Effectiveness of implementation of sickle cell disease referral guidelines and other measures in paediatric department at a tertiary hospital in Saudi Arabia.","authors":"Abdulrhman Alathaibi, Muhammad Matloob Alam, Hamdan Alghamdi, Jean Barrientos De Asis, Reynan Bautista, Mansour Aladwani, Mustafa Mohamed Selim","doi":"10.1136/bmjoq-2024-002800","DOIUrl":"10.1136/bmjoq-2024-002800","url":null,"abstract":"<p><strong>Background: </strong>Sickle cell disease (SCD) is an autosomal recessive genetic blood disorder. It affects up to 2.6% of the Kingdom of Saudi Arabia population.</p><p><strong>Local problem: </strong>The paediatric haematology/oncology (PHO) team noticed that 75% of paediatric patients were inappropriately referred to the PHO department. Also, 86% of patients were investigated with unnecessary investigations followed by outpatient haematological clinic visits which cause financial burden to the hospital, job load for medical staff and psychological burden for families.</p><p><strong>Methods and interventions: </strong>We carried out an initial audit of PHO referrals and requested laboratory tests over a 3-month period (October-December 2022). The PHO team developed a Clinical Pathway Guidelines (CPG), algorithm for early SCD detection and consultation form for suspected patients with SCD. Staff education about the new CPG was done. In addition, a dedicated PHO physician was assigned to map all referrals and provide rapid responses or outpatient department appointment dates for daily consultations and referrals. Furthermore, posters illustrating the algorithm for early SCD detection were printed and distributed to various units.</p><p><strong>Results: </strong>The percentage of inappropriately referred patients improved during the three-quarters to reach above the desired target of 10%. This per cent reached 0% by the end of Q3 September 2023, indicating a sustainable improvement. Also, the per cent of unnecessary laboratory tests decreased from 86% before starting the project to 0% by the end of Q3. Finally, the number of wrong outpatient haematology visits decreased from 2 to 4 visits/week to 0 visits.</p><p><strong>Conclusions: </strong>Staff education and adherence to guidelines are major priorities for the implementation of SCD referral guidelines in the paediatric department. This improves the utilisation of hospital resources, decreases the staff workload, hospital costs for unnecessary investigations and enhances the psychological care for families of patients with SCD.</p>","PeriodicalId":9052,"journal":{"name":"BMJ Open Quality","volume":"14 1","pages":""},"PeriodicalIF":1.3,"publicationDate":"2025-01-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11751959/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142944287","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Enhancing end-of-life care practices on the medicine units: perspectives from nurses and families.","authors":"Julie C Reid, Neala Hoad, Lucinda Landau, Anne Boyle, Rajendar Hanmiah, Deborah J Cook","doi":"10.1136/bmjoq-2024-003024","DOIUrl":"10.1136/bmjoq-2024-003024","url":null,"abstract":"<p><strong>Background: </strong>Death is a part of life. While most often a sombre event, opportunities exist to optimise the experience both for the dying patient and their loved ones. This is especially true in institutionalised settings, such as acute care hospitals where cure and recovery tend to be paramount.</p><p><strong>Purpose: </strong>To understand ways to improve end-of-life (EOL) care from the perspective of frontline nursing staff and patient and family advisors (PFAs).</p><p><strong>Methods: </strong>We conducted focus groups with frontline nursing staff (n=14) and PFAs (n=5) to understand ways to optimise EOL care. Using a videoconference platform, one researcher used a flexible interview guide while a second researcher took field notes. These focus groups were in follow-up to a comprehensive need assessment survey as part of a programme to enhance EOL care practices on the general internal medicine units at our hospital. We used source data from deidentified audio recordings and researcher field notes.</p><p><strong>Results: </strong>Five important categories regarding current EOL care practices emerged: communication among key stakeholders, assessment and management of symptoms, engagement of the palliative care team, engagement of the spiritual care team and ongoing tests and interventions at the EOL. We identified challenges specific to each respondent group as well as common challenges from both the professional and public perspectives.</p><p><strong>Conclusions: </strong>Views elicited from patients, families and nurses in this qualitative study have informed the development of strategies to enhance EOL practices in our hospital that may be useful in othercentres.</p>","PeriodicalId":9052,"journal":{"name":"BMJ Open Quality","volume":"14 1","pages":""},"PeriodicalIF":1.3,"publicationDate":"2025-01-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11751944/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142944321","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Interventions to increase utilisation of advanced care planning documentation for hospitalised older adults.","authors":"Laura E Walker, Anne Liwonjo, Deepi G Goyal","doi":"10.1136/bmjoq-2023-002703","DOIUrl":"10.1136/bmjoq-2023-002703","url":null,"abstract":"<p><strong>Objective: </strong>Understanding patients' wishes and preferences during hospitalisation is a crucial component of care. We identified a gap related to documentation of advance directives and patient preferences for care and focused on ensuring appropriate goals of care discussions were occurring and documented. Our aim was to improve the documentation of advance care planning notes to include 80% of targeted hospitalised patients.</p><p><strong>Patients and methods: </strong>Hospitalised patients in two community hospitals were included. We performed serial Plan-Do-Measure-Act cycles. The first intervention introduced the 'surprise question' during an afternoon huddle. Intervention 2 emphasised documentation of the advance care planning note. The third intervention used a structured approach led by administrators at daily multidisciplinary huddles and identified patients with an Elderly Risk Assessment score of 16 or greater as targets for advance care planning documentation.</p><p><strong>Results: </strong>From a baseline performance under 10%, we increased to greater than 80% of patients with Elderly Risk Assessment scores of 16 or higher having documented advance care planning. We were able to sustain this performance over subsequent years.</p><p><strong>Conclusion: </strong>A structured approach that identifies a targeted population at higher risk of mortality, and implementation of a checklist at a daily multidisciplinary huddle provided sustained improvement in advance care planning documentation. This provides the opportunity for improved patient care that is aligned with their values and preferences.</p>","PeriodicalId":9052,"journal":{"name":"BMJ Open Quality","volume":"14 1","pages":""},"PeriodicalIF":1.3,"publicationDate":"2025-01-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11751896/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143021759","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}